The State of the Art in Elder Justice

Yale Law School hosted a program on February 16, 2024, titled, Innovative Elder Justice: New Ways of Using Law, Medicine, and Technology to Address Abuse and Financial Exploitation in an Aging Society. The organizers and speakers were a “who’s who” of thought leaders in law and aging and I am so glad I attended. 

The program was opened with remarks from Richard Blumenthal, US Senator from Connecticut. Senator Blumenthal is an active member of the United States Senate Special Committee on Aging, organizing and participating in hearings.  He pointed out that abuse and exploitation are a bipartisan issue, abuse happens to persons of all political stripes, and bipartisan issues are most likely to make progress in Washington DC today.  He talked about the emerging issues of artificial intelligence, and voice cloning that scammers are using.  He pointed out the need for both reporting and oversight.  Reporting relies on the reporter; oversight looks beyond the numbers to fully understand what is happening and why.  While abuse and guardianship laws are state laws, he talked about the federal leadership in supporting the states.

One panel featured luminaries in academia, including, Nina Kohn from Syracuse and Yale Law Schools, Laura Mosqueda from USC School of Medicine and director of the National Center on Elder Abuse, Kathy Greenlee with Advancing States and former Assistant Secretary for Aging, and Marie-Therese Connolly of the RISE collaborative and author of “The Measure of Our Age,” a great book published last year. This panel spoke of the essential need to balance safety and autonomy in a person-directed way. The “restorative justice” model offers an example of how to do this effectively. The response to abuse must be interdisciplinary.   Most exploitation is perpetrated by people who know the person they are stealing from. The fear of loss of independence or loss of social contact is a leading reason for both the underreporting of abuse and exploitation and resistance to investigation and intervention.  Laura Mosqueda said “We must go upstream with education” about abuse and exploitation.  We need to look at the risk factors for abuse and exploitation and provide support and services to prevent maltreatment. MT Connolly said, “Our biggest failure is a lack of prevention.”  Kathy Greenlee reminded attendees that self-advocacy is often missing in the prevention and response to abuse.  

Another panel included leading voices in advocacy and health care. This panel was moderated by Alison Herschel of the Michigan Elder Justice Initiative and Rebecca Innantuoni with the Yale Geriatric and Palliative Care Medical Legal Partnership and included Liz Loewy, the former Chief of the Elder Abuse Unit at the Manhattan District Attorney’s Office, Faud Abujarad of the Yale School of Medicine, and Bonnie Olden of the Keck School of Medicine at the University of Southern California. The panel talked about the under-reporting of abuse. Under-reporting is often a result of fear, shame, and stigma attached to reporting. There is a concern that mandatory reporting may lead to persons who are experiencing maltreatment not disclosing to healthcare providers and other professionals who may be able to help.  The need to train and support caregivers as a tool to prevent abuse was discussed. There is widespread agreement that family, close friends, and caregivers commit most acts of abuse, but little effort put into prevention by training and supporting family caregivers. The expansion of medical-legal partnerships offers great hope of an interdisciplinary approach to prevention and intervention.  There was also discussion of the increased use of technology and artificial intelligence to spot anomalies that are indicative of abuse, neglect, or exploitation.  Systems are being developed to train a wide array of professionals on questions to ask, that lead, often indirectly, to a person who is being abused, neglected, or exploited.  

The closing speaker was David Owen, a writer for The New Yorker, with a personal narrative of his mother being financially exploited in a classic lottery scam.  His touching first-hand account illustrated how well-meaning people with strong families are manipulated by criminals looking to steal their life savings. 

A common theme throughout the day was that funding for research is hard to get without data, and data is hard to get without funded research. A challenge with data is states vary widely in who is eligible for services under adult protective services, and how abuse and exploitation are defined in state law. There are impediments in privacy laws that make it difficult or impossible for investigative agencies to get or share information that is critical to stopping financial exploitation.  Congress and states can change those laws and policies.  Pre-paid cards and cryptocurrency are empowering thieves and are often impossible to trace or stop. There is a need for uniformity as abuse is one of the few areas that does not have a uniform or model law for states to use when updating state laws. 

The program was offered without charge to attendees and made possible by the Oscar M. Ruebhausen Fund. I sincerely hope that this is the first in a series of these programs.